AU2015230977A1

AU2015230977A1 - Apparatus and method for improved assisted ventilation

Info

Publication number: AU2015230977A1
Application number: AU2015230977A
Authority: AU
Inventors: Clay NOLAN
Original assignee: Colabs Medical Inc
Current assignee: Colabs Medical Inc
Priority date: 2014-03-21
Filing date: 2015-03-23
Publication date: 2016-11-10
Also published as: CA2979819A1; EP3747490B1; WO2015143452A1; JP2019205862A; EP3119461A4; JP7086900B2; EP3119461A1; EP3747490A1; EP3119461B1; JP2017509462A; AU2020201241B2; AU2020201241A1; ES2805083T3; JP6568196B2; ES2975327T3; CA2979819C

Abstract

Devices and methods for allowing for improved assisted ventilation of a patient. The methods and devices provide a number of benefits over conventional approaches for assisted ventilation. For example, the methods and devices described herein permit blind insertion of a device that can allow ventilation regardless of whether the device is positioned within a trachea or an esophagus. In addition, the methods and device allow for timed delivery of ventilations based on a condition of a thoracic cavity to increase the amount and efficiency of blood flow during a resuscitation procedure.

Description

PCT/US2015/022079 WO 2015/143452

Apparatus and Method for Improved Assisted Ventilation

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001j The present is a non-provisional application of U S Provisional Application 61/969,043 filed March 21,2014 and is a continuation-in-part of U.S. Patent Application 14/296,298 filed June 4,2014 which is a continuation of U.S. Patent Application 13/659,699 filed October 24,2012 which claims benefit to U.S. Provisional Application No. 61/569,169 filed December 9, 2011, the content of each of which is incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

[0002] intubation is the placement of a tube of an intubation device into an airway lumen of the body of a patient to provide assisted ventilation of the lungs to maintain a supply of oxygen to the blood in those cases where the patient is unable to breathe on his other own. intubation in cases of respiratory distress involves the placement of a tube into the trachea of the patien t. Tracheal intubation also involves the positioning of an endotracheal tube into a patient’s trachea through the vocal cords, so the caregiver must also be careful to avoid injuring the vocal cords, In many cases, care must be taken when intubating a patient since improper placement of the tube can result in. additional harm to the patient. For example, many conventional intubation devices rely on an inflatable cuff that forms a seal against the lumen wall to maintain a position of the tube within the lumen. Over-inflation of the cuff, can cause internal bleeding in the patient. Another significant problem is that extreme care must be taken to avoid positioning the intubation tube within tire esophagus rather than the trachea, in such cases, with conventional devices, the first responder or medical practitioner cannot properly ventilate the patient and the patient can suffer further injury.

[0003] Even properly trained medical caregivers and first responders must proceed with caution during intubation to avoid misplacement of the intubation device or to avoid unwanted insertion errors and risk of injury. Delay and/or misplacement of the endotracheal tube, such as misplacement of the endotracheal tube into the esophagus, can potenti ally result in neurological damage or death, improper positioning of the endotracheal tube also can compromise airway protection or result in inadequate 1 PCT/US2015/022079 WO 2015/143452 ventilation, it is therefore imperative to intubate a patient quickly and position the endotracheal tube correctly when a medical condition arises.

[(1004] To reduce the risk of complications during intubation, the caregiver, whether a first responder, such as an emergency medical technician, paramedic, or a nurse or physician must proceed as quickly as possible yet with caution to avoid the potential complications. In addition, a first responder must often attempt to intubate the patient in a less than desirable location such as a bathroom, restaurant, or other area not. conducive to providing proper medical treatment and care.

[0005] Assisted ventilation in cases of cardiac arrest also requires prompt and accurate placement of an intubation device within the trachea so that chest compressions can occur. In such cases, intubation allows for ventilation of the lungs and a supply of oxygen to the blood while chest compressions provide circulation of the blood.

[0000] The American Heart Association’s protocols for cardio pulmonary resuscitation (CPR) previously required pausing after every fifteen chest compressions to allow for two ventilations. The American Heart Association’s 2010 protocols decreased the frequency of ventilations such that chest compressions are to be paused after every thirty compressions to allow for two ventilations, it is believed that the main reasons supporting the change in protocol are: 1) reduce the amount of intra-thoracic pressure associated with positive pressure ventilations since positi ve pressure ventilations decrease the efficiency of the heart; and 2) to minimize the interruptions of chest compressions to maintain constant arterial pressure. Accordingly, now most caregivers only simultaneously ventilate the patient and provide compressions if the patient is properly intubated.

[0007] F IG. 1 provides a partial view of a patient’s oral cavity 10, tongue 12 and pharynx 14 where the pharynx 14 is the membrane-lined cavity at the rear of the oral cavity 10. The pharynx 14 includes openings of the esophagus 16 and trachea 18, As shown, the openings to the esophagus 16 and trachea 18 are adjacent to one another. When a medical caregiver attempts to intubate a patient, the caregiver shall attempt to position the intubation device within the trachea 18 to provide oxygen to the lungs 2, As noted above, the caregiver shall attempt to avoid positioning the intubation device within the esophagus 16 and in doing so often must proceed slowly and with caution to avoid causing undesired trauma to vocal cords or other structures within the body, [0008] The wall of the esophagus 16 is composed of striated and smooth muscle. Since the esophagus 1.6 relies on peristalsis to move food downward towards the stomach, the walls of the esophagus 16 are naturally compliant and do not have any structural PCT/US2015/022079 WO 2015/143452 reinforcement The trachea IS, on the other hand, is relatively stronger and is naturally designed not to collapse given its function of transporting air to the bronchi and lungs 2. The wait of die trachea IS includes a number of cartilaginous semicircular rings 20 that prevent the trachea 18 from collapsing. The trachea 20 lies anteriorly to the esophagus 16 where tire openings of the esophagus 16 and trachea are separated by a tiny flap., the epiglottis 22. The epiglottis 22 protects the trachea when the individual swallows food or other substances.

[0009] FIG. 2 illustrates a conventional device SO used for intubating a patient. As shown, the device 50 is inserted through the mouth and oral cavity into the trachea 18. The caregiver must navigate the device 50 into the trachea 18 rather than the esophagus while traversing the epiglottis 22 and vocal cords 24. The caregiver must fake particular care to avoid causing damage to the vocal cords 24. Once properly positioned, the caregi ver can optionally inflate 52 a balloon on the device 50 to anchor the device within tire trachea IS. After the caregiver confirms placement of the device 50, ventilation of the patient can take [0010] Presently, the Combitube, supplied by Neiicor, is commonly used for airway management. The Combitube, also known as a double-lumen airway, is a blind insertion airway device (B1AD) used by first responders as well as in an emergency room setting. The Combitube is intended to allow for tracheal intubation of a patient in respiratory distress by use of a cuffed, double-lumen tube. The double lumen tube is inserted into the patient's airway to allow for ventilation of the patient’s lungs. Inflation of the cuff allows the device to function similarly to an endotracheal tube and usually closes off the esophagus, allowing ventilation and preventing pulmonary aspiration of gastric contents. [00111 However, placement of traditional intubation devices is very difficult due to the risk of improperly positioning the device. The risk of a device being improperly positioned can be fatal if not recognized. The conventional devices described above require positioning by an individual that is well trained in positioning such devices. Furthermore* even well trained individuals must proceed with caution when placing conventional devices, [ 0012] In addition, there remains a need to improve timing of air delivery' during artificial ventilations of a patient. This need especially remains where the patient is experiencing distress and requires both ventilation for oxygen and chest compression to reestablish blood circulation. Presently, if the act of artificially ventilating the individual (e.g.. through assisted ventilation or mouth-to-mouth) and providing chest compressions is 3 PCT/US2015/022079 WO 2015/143452 not timed, such as during normal CPR, normal artificial ventilation of the individual can work against the effectiveness of the compression. For instance, assisted ventilation by repeatedly delivering a large bolus of air can raise the pressure within the thoracic cavity and increase resistance by raising pressure on the heart. This back pressure can prevent the heart and l ungs from filling with blood. As a result, impeding the ability of the heart and lungs to fill with blood, makes the chest compression less effective as a lower volume of blood is circulated after the compression. {0913} There remains a need for a ventilation device and/or system that can effectively ventilate individuals and can be effectively positioned with minimal training required by the caregiver. In addition, there remains a need for such ventilation devices and methods to optimize the effect of providing assisted ventilation with chest compressions to circulate oxygenated blood within an individual.

SUMMARY OF THE .INVENTION

[0014) The present disclosure includes devices and method allowing for improved assisted ventilation of a patient. The methods and devices provide a number of benefits over conventional approaches for assisted ventilation. For example, the methods and devices described herein permit blind insertion of a device that can allow ventilation regardless of whether the device is positioned within a trachea or an esophagus. Some variations of the devices and methods allow minimally trained bystanders and laypersons to place an advanced airway for assisted ventilation. The devices described herein can be designed such that a single size can accommodate a variety of patient sizes thereby reducing the number of devices of varying sizes that must be kept in inventory. Additionally, having devices that can accommodate a wide range of individuals reduces the need of a first responder to assess the anatomic features of a patient prior to acting on the patient. In patients undergoing cardiac distress, delivery of large boluses of air during CPR can result in hyperventilating the patient, which can decrease the effectiveness of CPR. Elevated hitrathoraeic pressure can ultimately reduce the effecti veness of chest compressions. Variations of the current device and methods allow for controlled ventilation, which avoids hyperventilation.

[0015) In another variation, the devices described in the present disclosure allow for improved assisted ventilating an individual. For example, a variation of the method includes inserting a ventilation device into the individual by advancing a working end of 4 PCT/US2015/022079 WO 2015/143452 the yewfilaiiaa device within a body passage of the individual, where the working end includes a far opening fluidly coupled to a first lumen and a medial opening fluidly coupled to a second lumen; drawing suction through the opening and attempting to hold a vacuum through the first lumen and the far opening for a pre-determined period of time; automatically ventilating the individual through the second lumen upon detecting the vacuum during the pre-determined period of time and maintaining suction to maintain the vacuum; and automatically ventilating the individual through the first lumen upon failure to detect the v acuum during the pre-detennined period of time; where automatically ventilating the individual occurs at a pre-determined timing; measuring a condition of a thoracic cavity to determine a change in the thoracic cavity; and altering a timing of automatically ventilating of the individual upon detecting the change in the condition of the thoracic cavity. 10016] The present disclosure also includes a system artificially ventilating an individual, the system comprising: a ventilation device configured for insertion within a respiratory opening of the individual and having a working end for positioning within a body passageway of the individual, the ventilation device having a pressure sensor configured to detect pressure changes within the body passage; and the ventilation device having a control system configured to deli ver a bolus of air into an airway the individual at a pre-determined rate until detection of the pressure change within the body passageway, whereafter the control system is configured to alter the pre-determined rate by delaying delivery of the bolus of air until the sensor detects the pressure change in the air within the body passage, where the pressure change within the body passage results from a chest compression.

[0017| Measuring the condition of die thoracic cavity can include measuring the condition of the thoracic cavity using the ventilation device or measuring a change in a compression of a chest of the patient. For example, measuring the change of the compression of die chest of the patient comprises observing a force applied to the ventilation device by the body passageway. Alternatively, measuring the change of the compression of the chest of the patient comprises observing a deflection of the chest of the patient using one or more sensors on the chest.

[0018] in an additional variation, measuring the condition of the thoracic cavity comprises measuring a state of air flow within the thoracic cavity. Such .measuring can be performed using a sensor on the ventilation device and where measuring the state of air 5 PCT/US2015/022079 WO 2015/143452 flow within the thoracic cavity comprises detecting airflow, pressure, and/or volume using the sensor. Moreover, the sensor can monitor a direction of air flow.

The timing of the artificial ventilation can be altered by using the sensor to determine when a pressure in the body passageway increases and delivering air for automatically ventilating the individual when the pressure in the body passageway increases, or at least before the decrease, the pressure of the ventilations acts like and internal chest compression, then the recoil of the chest draws the air into the lungs. {0019] The methods can further include providing a feedback based on measuring the condition of the thoracic cavity, Such feedback can include information regarding the compression, where the information is selected from a phase, rate, efficiency, depth, and timing. The feedback can also be based on measuring the condition of the thoracic cavity com prises measuring a quality of the chest compression by determining a change in a volume of air in the thoracic cavity. In some variation, the feedback comprises information to increase or decrease a compression applied to a chest of the patient.

[0020 j V ariations of the method include altering the timing of the ventilation to initiate automatic ventilating of the indi vidual when a pressure increases, decreases, or reaches a maximum pressure in the body passageway. The method can further comprise continuing measuring the condi tion of the thoracic cavity to determine the change in the thoracic cavity after altering the timing of automatically ventilating of the individual and reverting to automatically ventilating the individual at the predetermined timing upon failure to detect the change in the thoracic cavity.

[0021] In an additional variation, the method can further include adjusting the ventilating device to suspend automatically ventilating the individual and manually ventilating the individual while maintaining suction to maintain the vacuum if the vacuum is detected.

[00221 The methods described herein can include a mask that is slidably positioned along the ventilation device and where the mask can be pressed against the individual with a manual actuator or trigger to isolate the respiratory opening of the individual from an external atmosphere. Typically, the mask will not be sealed against the patient during the automatic assisted ventilation. Therefore, during CPR the system is open. Sealing the mask against the patient and initiating a manual trigger can close the system and administering a bolus of air to manually ventilate the patient.

[0023] The methods described herein can further include electrically stimulating a heart of the individual using the ventilation device. 6 PCT/US2015/022079 WO 2015/143452 [0024] I» another variation, the method of artificially· ventilating an. individual can comprise inserting a ventilation device within a respiratory opening of the indi vidual and positioning a working end of the ventilation device within a body passageway of tire individual the ventilation device having a pressure sensor configured to detect pressure changes within the body passage; deli vering a bolus of air into an airway the individual at a pre-determined rate; altering the pre-determined rate by delaying delivery of the bolus of air when the sensor detects a pressure change in the air within the body passage, where the pressure change within the body passage results from a chest compression, [0025] The method can further comprise delivering the bolus of air into the airway of the individual occurs after a pre-determined delay. In some variations, the sensor is configured to intermittently detect pressure changes within the body passageway.

[0026] In another variation, the method further comprises, after altering the predetermined rate, the ventilation device resumes delivering the bolus of air at the predetermined rate if the pressure sensor fails to detect a pressure range within a first period of time.

[0027] In another variation, the method far ventilating an individual includes inserting a ventilation device within a respiratory opening of the individual and advancing a working end of the ventilation device within a body passageway of the individual where the w orking end includes a first opening fluidly coupled to a first lumen and a second opening fluidly coupled to a second lumen, where the second opening is located along the ventilation device proximal to the first opening; drawing suction through the first opening to induce collapse of the body passageway and maintaining the suction for a period of time; monitoring a thud parameter to determine whether the body passageway collapses; automatically ventilating the individual through the second lumen upon detecting collapse of the body passageway and maintaining suction to maintain the collapse of the body passageway; and automatically ventilating the individual through the first lumen upon failure to detect collapse of the body passageway ; wherein delivery of a bolus of air during automatically ventilating die individual occurs at a first timing; measuring a condition of a thoracic cavity to determine a change in the thoracic cavity; and altering the timing of the delivery of the bolus of air during automatically ventilating the individual upon detecting the change in the condition thoracic cavity.

[0028] In another variation, the present disclosure includes a method for artificially ventilating an individual by coupling a ventilation device to a respiratory' opening of a respiratory passage of the individual; positioning a pressure sensor in fluid communication PCT/US2015/022079 WO 2015/143452 with the respiratory passage, the pressure sensor configured to detect pressure changes within the respiratory passage; delivering a bolus of air into the respiratory passage of the individual at a pre-determined rate; and altering the pre-determined rate by delaying delivery of the bolus of air until the sensor detects a pressure change in the air within the respiratory passage, where the pressure change within the respiratory passage results from a chest compression. Such a method can include any device, including conventional ventilation devices.

[0029] The present disclosure also includes a system for artificially ventilating an individual using a source of oxygen, the system comprising: a ventilation device having a pressure sensor configured to detect pressure changes within the body passage, the pressure sensor being positioned on a portion of the device configured to be inserted Into a body passageway of the indi vidual; a controller configured to deliver a bolus of air into an airway the individual at a pre-determined rate, where the controller is configured to monitor the pressure sensor and upon detecting a pressure change, the controller alters the pre-determined rate by delaying delivery of the bolus of air.

[0030] The present disclosure also includes devices for ventilating an individual, in one example such a device comprises a tubular member having at least a first and second lumen, where the first lumen is fluidly coupled to a first opening located distally relative to a medial opening, where the medial opening is fluidly coupled to the second lumen, where the first opening and medial opening are each fluidly isolated within the tubular member; the tubular member being configured to measure a condition of a body lumen to determine a change in a thoracic cavity of the individual; a control system having a suction source and a gas supply lumen, the control system having a valve configured to fluidly couple the gas supply lumen to either the first lumen or to the second lumen; the control system also capable of drawing suction from the suction source through the first opening and first lumen, where the control system is configured to monitor the first lumen for a vacuum to indicate collapse of the body passageway and formation of a seal at the first openi ng; where the control system is further configured to selectively form a ventilation path from the supply lumen to the first lumen or second lumen by selecting the first lumen as the ventilation path if collapse of the body passageway is not detected; and selecting the second lumen as the ventilation path if collapse of the body passageway is detec ted; where the control system is configured to automatically ventilate the individual through the ventilation path at a first rate; and where the control system is further configured to alter the first rate upon de tecting the condition of the body lumen. 8 PCT/US2015/022079 WO 2015/143452 [00311 The system and methods described herein can be compatible with devices that monitor the concentration or partial pressure of carbon dioxide (€02) in the respiratory gases (capnography). Primarily such devices are monitoring tool for use during anesthesia and intensive care that monitor expiratory' €02 are of interest when rebreathing systems are being used. The ability to integrate the ventilation systems described herein with such capnography systems allows for improved patient care. Furthermore, the systems and methods described herein can be compatible with equipment found in emergency vehicles such as oxygen supplies and/or power supplies. In some variations, the system of the present disclosure can also provide audio or even video (through use of a display screen) instructions to ensure proper operation in those situations where the system may be used by first responders that are not trained emergency personnel.

BRI EF DESCRIPTION OF THE DRAWINGS

[0032] The invention is best understood from the following detailed description when read in conjunction with the accompanying drawings. It is emphasized that, according to common practice, the various features of the drawings are not to-scale. On the contrary, the dimensions of the various features are arbitrarily expanded or reduced for clarity·'. Also for purposes of clarity, certain features of the invention may not be depicted in some of the drawings. Included in the drawings are the following figures: [0033] FIG. 1 provides a partial view of a patient’s oral cavity, tongue, pharynx as well as esophagus and trachea. f 0034] FIG. 2 illustrates one example of a conventional device as used to intubate a patient [00351 FIG , 3 illustrates various components of an example of an improved ventilation system.

[0036] FIGS, 4A to 4€ i llustrate a partial sectional view of a working end of an improved ventilation device.

[0037] FIGS. 5 A to 5E show a representation of the process of ventilating a patient using an improved ventilation device. device.

[0038] FIGS. 6A to 6C show additional variations of a working end of a ventilation FIG. 7 illustrates a schematic of an electrically powered system. PCT/US2015/022079 WO 2015/143452 [0040j FIG, 8A shows an example of a component schematic for a pneumatically driven system as described herein, [004.1J FIG. SB provides a component listing for the schematic of FIG. 8A.

[0042] FIG. 8C shows a listing of various modes for the system, [0043] FIGS. 8D to SM illustrates various flow paths for the various modes of operation.

[0044] FIG . 9 A illustrates another variation of a device useful for providing assisted ventilation with improved outcomes by monitoring a condition of the thoracic cavity.

[0045] FIGS, 9B to 9C show a. partial isometric view and partial cross sectional views of the mask and trigger used to close the system and initiate manual ventilation.

[0046] FIGS. 1.0A and 10B ill ustrate examples of the working end of the device when inserted into a body passageway of an individual and monitoring a condition of the thoracic cavity.

[0047] FIGS. 11A and 11B illustrate a variation of a system for artificially ventilating an individual using a source of oxygen, such as those described herein.

[0048] FIG. 11C shows an external device being used to control the ventilator described herein.

[ 0049] FIG. 12 provides a schematic of a control system relying on the gas supply to provide a source for both ventilation and suction.

[0050] FIGS. 13-22 illustrate an example of the circuitry for sensing the phase, rate, depth and effectiveness of a chest compression with a resistor placed on the tube of an airway placed in foe patient's mouth, trachea or esophagus

DETAILED DESCRIPTION OF THE INVENTION

[0051] Before the devices, systems and methods of foe present in vention are described, it is to be understood that this invention is not limited to particular therapeutic applications and implant sites described, as such may vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present in vention will be limi ted only by the appended claims.

[0052] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to whi ch this invention belongs. The terms “proximal", “distal", “near” and “far" when used indicate 1.0 PCT/US2015/022079 WO 2015/143452 positions or locations relative to the user where proximal refers to a position or location closer to the user and distal refers to a position or location farther away from the user.

[0053] FIG. 3 illustrates various components of an example of an improved system according to the present disclosure. As shown, the ventilation device 100 includes a working end 1.02 that is inserted into a patient. The working end can include a distal tubing 104 that contains a first lumen (not shown), which extends through a distal opening 106 of the ventilation device 100 and is in fluid communication with a control unit (also called a ventilator) 150 and/or supply source 160 via one or more proximal tubes 118. The control unit 150 can also include an apparatus designed to provide suction as well as a collection canister. In operation, the control unit ISO directs suction or applies a vacuum through a first fluid path 122, which in turn causes a suction or negative pressure at the distal opening 106. The source 160 can comprise oxygen, air. or any other gas that is desired for ventilation of delivery into the lungs. The source 160 can be nested within physical construct of the controller 150. However, the source 160 can be optional so that the controller ventilates the patient only using ambient air.

[0054] The control unit 150 maintains the device 100 in this state for a set period of time and monitors the parameters of the pressure or flow parameters within the first lumen to determine whether to ventilate through the first or second. The example illustrated in FIG. 3 also includes a hub 1.08 with one or more features that aid in proper functioning of the device. Such features are described in detail below. Furthermore, the distal opening 106 can include any number of ports at the distal end of the device so long as the ports are in a fluid path with the first lumen. Likewise, the medial opening 112 can comprise any number of openings as long as those openings are in fluid communication with the second lumen. In addition, variations of the device can also be inserted through a nasal opening rather than a mouth, [0055j The ventilation device 100 further includes a proximal tubing 1.10 that houses a second lumen (not shown) that exits the device 1.00 at a medial opening 112. As discussed below, distal opening and first lumen are fluidly isolated from the medial opening and second lumen through the working end of the device 102 to the control unit 150. This fluid isolation allows the control unit ISO to determine which lumen to use to ventilate the patient. The control unit directs flow through a second fluid path 124 that is fluidly coupled to the second lumen and medial opening '1.12 when the device is positioned in the esophagus 16 rather than the trachea 18. PCT/US2015/022079 WO 2015/143452 [0056) The-ventilation system 100 illustrated in FIG. 3 also shows an optional mask 114 with optional venting ports 116. Variations of the system can include alternate configurations without a mask or with other such devices such as a mouth guard or any other commonly used mounting apparatus. As discussed below, the mask 114 or other mounting apparatus can he used to assist the caregiver in properly orienting the device 100 as it is inserted into the patient. Variations of the device can include a balloon, sponge or any other structure that secures the proximal region of the device to the patient to ensure that gas is directed to the lungs during inhalation. The mask (or other structure as described herein) can include a securing band, tape strip, or temporary adhesive to secure the mask in place on the patient. The mask or similar feature can be used to determine how fat to advance the working end 102 into the patient. Alternatively or in combination, the device 100 can include graduated markings 134 to assist the caregiver in properly advancing the device into the patient. The mask can be slidable to adjust the length from the mask to the distal or proximal opening.

[0057) FIG. 3 also shows a representative figure of a control system 150 with a number of controls 152 that allow for various device operative sequences, manual controls, or device overrides. For example the system 150 can include manual ventilation controls so that the caregiver can manually adjust inspiration and expiration of the patient. The controls 152 can include a reset or rapid ventilation mode for performing cardio pulmonary·' resuscitation. The controls 150 include a continuous airflow or continuous vacuum mode that can assist in clearing debris or bodily fluids from the body passages. The controls also allow caregivers to connect the device 100 directly to an endotracheal tube if the caregiver decides to intubate, in an additional variation, the system can allow for active ventilation consisting of blowing for a period and then sucking for a period through the active lumen in order to increase ventilation efficiency, in some variations, the system is configured so that the ventilation openings, as well as other openings on the tube do not rotate relative to the mask so that caregiver can align the openings wi th the trachea, [0058) The device shown in FIG. 3 can also include one or more electrodes positioned on the working end. For example, the hub 108 can serve as an electrode and apply electricity to the heart in order to defibrillate a patient out of an irregular rhythm or increase the heart rate or contractility. Additionally, one or more electrodes can be inserted on or embedded in a tube designed to be placed in the patient’s mouth, esophagus or trachea.

Such placement will be beneficial because it would allow the operator a mom direct route of electrical stimulation of the heart compared that the current use of pads placed on the 12 PCT/US2015/022079 WO 2015/143452 patient’s chest. A tube placed in the esophagus would more easily be able to detect a pulse because of the major arteries running parallel to the esophagus. This would allow rescuers to determine a pulse without having to touch the patient. It would also allow an untrained bystander to administer CPR who was not trained on checking for pulsed, in addition, the pressure sensors, as described below, can be placed on the tube that had been advanced into the patients mouth that may be pressing against major arteries would be able to detect if there was a change in pressure.

[0059] In additional variations, the control system 150 can be integrated into one or more parts of the devi ce body 102 rather than being a separate stand-alone box type configuration. In addition, the ventilation system 100 can be optionally configured to work with a defibrillator. Alternate variations of the system 100 can be configured to provide an audible, visual, or tactile sensation to indicate when a caregiver should administer chest compressions.

[0060] FIG, 3 also shows the depicted variation of the device 100 as having an optional balloon 132 or other expandable member located on a working end. When used, the balloon can be positioned anywhere along the device adjacent to the distal opening 106, Alternatively, or in combination, a balloon can be located adjacent to the medial opening.

[0061] The various tubing forming the device 100 should be sufficiently flexible so that the device can be navigated through the upper respiratory' system. Alternatively, or in addition, porti ons of the tubing can be constructed to withstand being collapsed by the patient's mouth or teeth, in additional variations the system 100 can be designed such that the distance between the distal opening 1.06 is adjustable relative to the medial opening 112 and/or the mask 114 (or even moveable relative to the graduations 134). A similar variation includes a medial opening 112 that can be adjustably positioned relative to the distal opening 106, mask 114 and or graduations 1.34 [0062] FIGS. 4A to 4C illustrate a partial sectional view of an airway unit or working end 102 of a ventilation device 100 as described herein.

[0063] FIG, 4A illustrates a first lumen 128 that is fluidly coupled to a distal opening 106 and a second lumen 130 that is fluidly coupled to the medial opening 112 where the first and second lumens 128 and 130 are fluidly isolated from each other as described above. FIG. 4A also illustrates that the spacing 126 between the distal opening 106 and the medial opening 112 can be selected based on the intended patient. For example, since the medial opening 112 is intended to be positioned in or around the pharynx when the distal Opening 106 is positioned in the esophagus or trachea, the spacing 126 can be selected for PCT/US2015/022079 WO 2015/143452 •an indi v idual of average build. In most cases, the working end 102 of the ventil ation device 100 will comprise a single use disposable component Accordingly, the ventilation device 100 can include a number of disposable components having different spacing 126 between the medial 112 and distal 106 openings. For instance, the varying spacing can accommodate infants, toddlers, young children, as well as various body sizes.

[0064} FIG. 4B illustrates a parti al cross sectional view of the working end 102 of the ventilation device of FIG. 4A. Once the device is properly positioned within, the patient, the control unit ISO applies a suction or vacuum through a first fluid path 122, then through the first lumen 128 and ultimately causing a vacuum at the distal opening 106 as denoted by arrows 30. In additional variations, the operator or caregiver may choose to clear food or other debris .from the patient by delivering air through the first lumen 128 or by attempting to use the suction at the distal opening to remove particles or other bodily fluids. The system 150 shall continue to pull a vacuum through the first lumen 130 for a period of time, if the device 100 is properly positioned within the trachea (as discussed below), die system 150 will begin to ventilate through the first lumen 128. In other words, the system 100 will begin to cyclically deliver oxygen or other gas from the source 160 and remove carbon dioxide front the patient to properly ventilate the patient’s lungs, in this situation, flow is not required through the second lumen 130 and medial opening 112. Although FIG. 4B shows the first lumen 1.28 to be located within the second lumen 130 any number of variations can be used. For example, die lumens can be concentric or parallel.

Additional variations even allow for the lumens to be in fluid communication where one or more valves determine whether ventilation occurs through the distal opening or through the medial opening. The device can incl ude any number of safety checks to confirm placement of the device doesn’t change. For example, once the device confirms placement in the trachea, it can re-perform a check to ensure that it is placed in the trachea over a predetermined interval. Alternatively, it can perform this check on a sliding scale (e.g., 1st check at 30 second, 2ηύ check at 2 minutes, 3rd check at 10 minutes, etc.). In an additional variation, the system is designed to provide a safety check to ensure that the suction filter is not clogged causing a misread of position. In such a case the device gives ventilation out the distal port once a vacuum is detected. This ventilation bolus can be small or large. By monitoring vacuum and determining if it is lost during the distal air bolus, the device knows that the seal was at the esophagus and resumes suctioning distally and ventilation through the proxi mal ports. If the vacuum is not lost during the distal air bolus the device PCT/U S2015/022079 WO 2015/143452 can assume that the filter is dogged and an error signal will indicate for the operator to replace the working end of the device or to check for obstructions, [0065] The system 150 can comprise the mechanism that ventilates and produces suction or a vacuum. Generally, the system ISO is reusable (as opposed to the working end that is generally disposable). The system 150 can be portable, affixed to an ambulance or other emergency vehicle or build within a cart or room. Variations include battery powered devices, pneumatic powered devices, or devices that require a power source (such as an AC outlet).

[0066] FIG. 4C illustrates die condition where the distal opening 106 is positioned within the esophagus. In this situation the control unit ISO directs ventilation through the second lumen 130. As shown by arrows 32. because the medial lumen 112 is fluidly coupled to the second lumen 130 ventilation 32 takes place at die medial opening 112. [00671 FIGS. 5 A to 5E show a representation of the process of ventilating a patient using a ventilation device 100 as described herein.

[00681 FIG. 5A illustrates the ventilation device 100 as a caregiver advances the device lOOinto the oral cavity 10 over the tongue 12 and into the pharynx 14. At any time during the procedure, the caregiver can manually operate the device to suction fluids, food particles, or other items from the body. As described herein, the caregiver can “blindly” advance the working end 1.02 into the patient. As a result, the working end 102 will either end up in the esophagus 16 or trachea 18 of the patient.

[0069] FIG. 5B illustrates the condition where the caregiver advances the working end 102 into a trachea 18 of an individual Once the caregiver places the device 100, the caregiver can initiate the control unit 150 to start the process to determine placement of the device 100. Alternatively, one or more sensors on the device can automatically trigger actuation of the control unit. In either case, the control unit draws a vacuum through the di stal opening 106 for a predetermined period of time. The vacuum reduces pressure and draws air within the distal opening 106. The con trol unit 150 then assess a state of the device by monitoring the vacuum, airflow, or any other fluid parameter that would indicate whether the walls of the body passage, in this case the trachea 18, collapsed causing the formation of a vacuum seal, in those cases like FIG. 5B where the device is situated within the trachea, the suction 30 will have little effect on the walls of Are trachea 18. As noted above, the walls of the trachea 18 are reinforced with rings of cartilage 20 that provide structural rigidity of the airway. Because the controller 150 will not detect the formation of a vacuum seal at the distal opening 106 (or within the first lumen) the system registers the PCT/US2015/022079 WO 2015/143452 distal opening 166 as being properly positioned in the trachea IS (rather than the esophagus 16) and, after a predetermined period of time (e.g., 10-1.5 seconds), die controller 150 ceases to draw a vacuum and begins to ventilate the patient’s lungs by alternating between delivery of the gas from the gas supply 160 and removing carbon dioxide. As a result, the first lumen is used as a ventilation lumen. It will be important for the controller 150 to differentiate changes in vacuum or flow that result from suctioning of fluids or debris. In some variations of the device, the controller 150 is configured to identify formation of a seal when the vacuum builds or flow' drops to a sufficient degree such that the device has formed a vacuum seal rather than suctioned fluids or a substance.

[00701 T he control unit 150 can determine whether or not a seal is formed by measuring strain on a suction motor (or similar apparatus such as a venturi, device that produces a vacuum) that causes the negative pressure within the main lumen for suction. If the control unit ISO observes zero or minimal strain on the suction motor after a predetermined time, then the control unit 150 will use the first lumen as the ventilation lumen. [00711 FIG. 5D illustrates a state where the caregiver advances a working end 102 of the ventilation device 100 into an esophagus 16 rather than the trachea 18. Similarly to the state depicted by FIG, 5B above, once the caregiver positions the device 100, the caregiver can initiate the control unit 150 to start the process to determine placement of the device 100. As noted abo ve, addit ional vari a tions of the device and system can include one or more sensors that can automatically trigger actuation, of the control unit [0072] FIG. 5D depicts the state where the control unit 150 pull vacuum through the distal opening 106 for a predetermined period of time. The vacuum reduces pressure and draws air within the distal opening 106. The control unit 1.50 then assess a state of the device by monitoring the vacuum, airflow, or any other fluid parameter that would indicate whether the walls of the body passage, in this case the esophagus 16 collapsed. As shown, the walls partially or totally collapse resulting in formation of a vacuum seal at the distal opening 16. As noted above, muscles form, the walls of the esophagus 16. There is no reinforcing structure in the esophagus as opposed to the cartilage rings in the trachea 18. The control unit can be confi gured to monitor the formation of a vacuum seal and if the seal remains for a predetermined period of time, the control unit ISO directs ventilation 40 in and out of the medial opening 112 as depicted in FIG. 5E. As shown and discussed above, the spacing between the distal opening 106 and medial opening 112 can be selected such that the medial opening remains in or near the pharynx 14. However, variations of the 16 PCT/US2015/022079 WO 2015/143452 device permit the medial opening to eater the esophagus 16 so long as tire opening 112 can continue to ventilate the patient.

[0073] Because the control unit 150 will not detect the formation of a vacuum seal at the distal opening 106 (or within the first lumen) the system registers the distal opening 106 as being properly positioned in the trachea 18 (rather than the esophagus 16) and, after a pre-determined period of time, the control unit ISO ceases to draw a vacuum and begins to ventilate the patient’s lungs by alternating between delivery of the gas from the gas supply 160 and removing carbon dioxide. In this situation the device uses the second lumen as a ventilation lumen. One additional benefit of positioning the working end 102 of the device 1.00 within the esophagus 16 is that the vacuum seal produces an anchoring effect that maintains the device in position. This feature eliminates the need to secure the mask or other feature about the patient’s head, neck or face. In addition, if a caregiver inadvertently pulls the device 100 while a seal is formed, the vacuum seal is simply broken and the device releases from the esophagus 16. This provides a safety improvement over conventional ventilation devices that rely on an expandable balloon, which if pulled, can cause trauma to the patient’s airways, vocal, cords, or other structures.

[0074] In certain variations, the device 100 shall cease ventilating after a period of time and produce suction through the distal opening. Such a step is considered a safety feature in the event that the working end is moved, repositioned, etc.

[0075] FIGS. 6A to 6€ show variations of the working end 102 of a ventilation device as described herein. FIG. 6A illustrates a hub having an opening 106 that is surrounded by a contoured surface. The contoured surface can assist reducing the chance that the distal opening 106 becomes clogged due to food particles or other fluids. This feature also assists in reducing the occurrences that the control unit misreads an opening 106 that is obstructed (with food particles or other bodily fluids) for an opening that formed a seal with the wails of the esophagus. FIGS. 6B and 6C illustrate additional variations of a working end 102 of a ventilation device. In these variations, the working end 102 can be fabricated with or without a hub. FIG, 6B illustrates a straight tube having a plurality of openings 106. FIG. 6C illustrates a beveled end having an opening 106.

[0076] As noted above, the device described herein can be pneumatically driven using compressed gas and valves or electrically controlled. FIG. 7 illustrates a schematic of an electrically powered device using a suction motor, air compressor and circuitry to switch between a first fluid path 122 (ultimately fluidly coupled to a distal opening) and a second fluid path 124 (ultimately fluidly coupled to a medial opening). 17 PCT/US2015/022079 WO 2015/143452 [0077) FIG, 8A shows an example of a component schematic for a system as described herein that is pneumatically driven. FIG. 8B provides a list of the components found in FIG. 8A. The valves operate in multiple states based on the conditions discussed above. The fol lowing description illustrates an example of the different states of the components found in the component schematic of FIG- 8A.

[0078) Medial Supply Valve PI (4/2):

State 1 (nominal, spring return); Controls the 15s timing of vacuum supply through Distal Supply Valve P2;

State 2 (actuated): Provides supply for medial ventilation;

Pi lot Actuation; iO'TIg vacuum [0079) Distal Supply Valve P2 (4/2)

State 1 (nominal, spring return); Provides supply for Vacuum Generator;

State 2 (actuated): Provides Supply for Distal Ventilation;

Pilot Actuation: 40psi from flow-controlled output of Medial Supply Valve,

State 1, [0080) Pulse Valve P3 (3/2 Normally Open);

State 1 (nominal, spring return): Fills Accumulator volume at flow-controlled rate until set pressure is achieved at inline Relief Valve;

State 2: (actuated): Dumps accumulator volume to Ventilation Selector Valve through quick exhaust;

Pilot Actuation: 5psi from output of inline Relief Valve [0081) Ventilation Selector Valve P4 (3/2 Fully Ported);

State 1 (nominal, spring return): Routes output of Pulse Valve to Medial Ventilation Output;

State 2: (actuated): Routes output of Pulse Valve to Distal Ventilation Output; Pilot Actuation: 40psi from output of Distal Supply Valve. State 2 [0082) Operation Valve Ml (Manual Toggle, 3 position. All Detent);

State 1 (toggle down, “ON”): Provides supply for Medial Supply Valve and Distal Supply Valve;

State 2 (toggle centered, ‘OFF/RESET”): Blocks supply, vents system;

State 3 (toggle up, “VACUUM”): Bypasses all valves, provides supply to Vacuum Generator.

[0083)

Mode Valve M2 (Manual Toggle, 3 position, De^fc/Detent/Momentary);

State 1 (toggle down, detent, “ΥΕΝΏΙΑΤΕ”): Provides supply for Pulse Valve PCT/US2015/022079 WO 2015/143452 and Ventilation Selector Valve;

State 2 (toggle centered, detent, “BYPASS"): Blocks supply to Poise Valve and Ventilation Selector Valve,

State 3 (toggle up, momentary spring return, ‘ΌΝ-DEMAND"): Blocks supply to Pulse Valve, provides continuous flow-controlled supply to Ventilation Selector Valve (00841 The system illustrated by the component schematic of FIG. 8 A can have a variety of modes of operation. In one example, as shown by FIG. 8C, the system can include 8 separate modes of operations controlled by the position of various valves and the operation state of a medial supply valve, [0085) Mode 0, where the system is set to an Off position.

Ml set to OFF;

Main supply blocked; system vented; [0080] FIG. 8D shows Mode 1, where there is a continuous vacuum applied through the sytem.

MI set to VACUUM

Ventilation system bypassed; vacuum at Vacuum Output; Vacuum Indicator on [0087] FIG. BE shows Mode 2, where the system engages in placement detection; M I set to ON;

Vacuum at Vacuum Output until P2 pilot activated (15s); Vacuum Indicator on; [0088] In Mode 3, the system engages in ventilation through the distal opening.

Ml set to ON; M2 set to VENTILATE;

No vacuum detected; P2 pilot activated; P4 pilot activated.

[0089] FIG. SF shows Mode 3 A, where an accumulator fills at controlled rate (0.67s) until inline Relief Valve activates (3Qpsi);

Distal Ventilation Indicator on, [0090] FIG. 8G shows Mode 3B: P3 pilot activates, dosing P3 and exhausting Accumulator volume through Quick Exhaust to P4; Distal Ventilation Indicator on.

[0091] Mode 4 - Medial Ventilation

Ml set to ON; M2 set to VENTILATE

Vacuum detected; PI pilot activated; vacuum at Vacuum Output.

[00921 FIG. BB shows Mode 4A where accumulator fills at controlled rate (0.67s) until inline Relief Valve activates (30psi);

Vac uum Indicator on;

Medial Ventilation Indicator on. 19 PCT/US2015/022079 WO 2015/143452 [0093J FIG, 81 shows Mode 4B: P3 pilot activates, closing P3 and exhausting Accumulator volume through Quick Exhaust to P4;

Vacuum Indicator on; Medial Ventilation Indicator on, j0094] FIG, 8,1 shows Mode 5 ~ Ventilation Bypass (Distal); MI set to ON; M2 set to BYPASS;

No vacuum detected; P2 pilot activated; P4 pilot activated; supply to P3 & P4 blocked; Distal Ventilation Indicator on.

[0095] FIG. 8K shows Mode 6 ~ On-Demand Ventilation (Distal); M I set to ON; M2 set to ON-DEMAND;

No vacuum detected; P2 pilot activated; P4 pilot activated; supply to P3 blocked; continuous flow-regulated flow to P4; Distal Ventilation Indicator on [0096] FIG. 8L shows Mode 7 - Ventilation Bypass (Medial); MI set to ON; M2 set to BYPASS;

Vacuum detected; PI pilot activated; vacuum at Vacuum Output; supply to P3 blocked;

Vacuum Indicator on;

Medial Ventilation Indicator on [0097] FIG. 8M shows Mode 8 - On-Demand Ventilation (Medial);

Ml set to ON; M2 set to ON-DEMAND;

Vacuum detected; PI pilot activated; vacuum at Vacuum Output; supply to P3 blocked; continuous flow-regulated flow to P4; Vacuum Indicator on; Medial Ventilation Indicator on, [0098] FIG, 9A illustrates another variation of a device useful for providing assisted ventilation with improved o u tcomes. T he features and aspec t of the illustrated example can be combined with any of the variati ons of the devices described herein. M oreover, the features of the devices described herein that improve the effectiveness of assisted ventilation can be used with conventional assisted ventilation devices.

[0099] As illustrated, assisted ventilation device 100 includes a working end Ι.Θ2 that is inserted into a patient. The working end can include a distal tubing 104 that contains a first lumen (not shown), which extends through a distal opening 106 of the ventilation device 100 and is in fluid communication with a control unit (also called a ventilator) 150 and/or supply source 160 via one or more proximal tubes 118, The control unit 1.50 can also include an apparatus designed to provide suction as well as a collection canister (not 20 PCT/US2015/022079 WO 2015/143452 show»)* As noted above, the device 100 can optionally include an improved control unit ISO that directs suction or applies a vacuum through a first fluid path 122, which in turn causes a suction or negative pressure at the distal opening 106. The source 160 can comprise oxygen, air, or any other gas dial is desired for ventilation of delivery into the lungs. The source 160 can be nested within physical construct of the controller 150, However, the source 160 can be optional so that the controller ventilates the patient only using ambient air. FIG. 9A also illustrates the device 1.00 as including features that allow the assisted ventilation device 100 to deliver ventilation in a manner that improves the effic iency of the assisted ventilation procedure .

[01001 For example, the improved device 100 can include one or more structures used to determine a change in the thoracic cavity. Such changes can include physical movement of the tissues within the thoracic cavity, the force applied to the working end 102 of the device 100, and/or the deflection of any part of the device 100. Alternatively, or in combination, a change in the thoracic cavity can comprise a change in the fluid environment of the thoracic cavity, including any body passageways that are in fluid communication with the thoracic cavity, e.g., the airway, the esophagus, etc.

[0101 j FIG. 9A illustrates the device 100 as being able to measure fluid parameters in the thoracic cavity via a sensor 180 located along a portion of the working end 102 of the device, .Although the sensor 180 is illustrated on the proximal tubing 110, the sensor 180 can be positioned along any portion of the device 100 that enables monitoring of the fluid, parameters of the thorac ic cavity and/or body passage in fluid communication with the thoracic cavity. For instance, the device 100 can include one or more sensors 180 positioned along the distal tubing '1.04 and/or hub 108. Moreover, variations of the device include one or more sensors positioned within the device 100, [0102] The sensor 180 can comprise a pressure sensor, flow sensor, transducer, or similar structure. Alternatively, in additional variations, the sensor 180 can comprise a lumen or passageway having an open end positioned as described above, where the lumen or passageway extends through the device via a sensor tubing 182 that allows the actual fluid parameters to be read by the actual sensor located within the device 100, tubing 118, and/or control unit 150.

[0103] The variation illustrated in FIG. 9A also shows a sensor 180 that is not flush with the proximal tubing 110 of the device 100. As shown, the measurement surface (e.g., the actual sensor or the sensor lumen 184 can be positioned so that tissue adjacent to the device 100 does not obscure or affect the readings of the sensor. However, additional 21 PCT/US2015/022079 WO 2015/143452 variations of .the device ,100 include sensors that are flash with the device body. In addition, pressure from the device 100 (e.g., die proximal tube 118 can be used to deliver air to the sensor 180 reduce obstructions from interfering with the measurement of any fluid parameter in the body lumen.

[0104] FIG. 9A also illustrates a force detecting component, such as a strain gauge, optic fiber, transducer, or similar force/movemeni detecting structure that can be located anywhere along the working end 102 of the device 100. The force detecting component 190 is shown as being on the distal tubing 104. however, one or more force detecting components 190 can be positioned along any portion of the device as long as the component 190 detects a force applied to the chest via a resulting force being applied to the device through movement of the tissue displaced by assisted chest compression.

[0105] fire presence of both the sensor 180 and the force detecting component 190 on a single device is for purposes of illustration only. Certain variations of the device can include any combination of force detecting component, sensor, or both.

[0106] FIG. 9A also shows the device as including a manual ventilation trigger 186. In operation, the medical caregiver can use the manual ventilation trigger 186 to manually deliver a bolus of air through the device 100. Alternati vely, or in combination, the manual ventilation trigger 186 can activate the sensor 180 or force detecting component. 190 to deli ver a bolus of air on demand. Such a feature can be useful if the care giver has obtained a pulse and intends on delivering assisted ventilation alone. Alternatively, the caregiver can use the manual ventilation trigger 186 to deliver a bolus of air through any part of the device in an attempt to clear bodily fluids that might otherwise obstruct the device. The manual ventilation trigger 186 can operate as the device performs the automated assisted ventilation where a bolus of air is delivered at certain period of time. Alternatively, or in combination, the manual ventilation trigger 186 can deliver a bolus of air when the ventilation device 109 (or controller ISO) is placed in a manual-mode.

[0107] In certain variations of the device, when initiating the manual, trigger 186, the device be programmed to maintain ventilation through the respective opening that was selected in the automatic mode. For example, if the device is placed in the esophagus, and then switched to manual operation, the control system can maintain suction to ensure that the esophagus closes the distal opening and forms a vacuum so that manual ventilation automatically proceeds through the proximal or medial opening 112. Likewise, if the device is positioned in the trachea, actuating the device in a manual mode will cause the bolus of air to be expelled from the distal opening of the device. PCT/US2015/022079 WO 2015/143452 [0108} 1b one example, the trigger 186 comprises a hollow button, attached to the device and inline with the tubing that connects to the sensor 180. When the button is pressed it sends an air bolus to the sensor 180 that signals the control system 150 to start assisted ventilation. The volume of air provided by the manual trigger 186 can be preset. Alternatively, air can be delivered until the caregiver releases the trigger 186 to stop the ventilation. In addition, mounting the trigger 186 mounted on the mask 114 is beneficial because it allows the caregiver to ensure the mask 114 is sealed against the patient’s face with one or two hands while operating the demand ventilations.

[0109] The manual trigger 186 can also operate to with one or more one-way valves (e.g., a flap that allows exhaust of air when the trigger 186 is not pressed). This ensures that there is no excess buildup of pressure in the airway and prevents barotrauma. This also allows spontaneous breathing. When the ventilator is switched to demand ventilation mode the lungs need to be isolated from atmosphere during die inhalation period only. This can be achieved by having the demand ventilation trigger 186 mounted on a flap that is above an opening on the mask. The flap is designed to be opened with when no pressure is being applied to the button, then once pressure is applied to the trigger the flap is sealed against the opening, closing the system and allowing air to inflate the lungs. When the button is released for exhalation the flap is comes off the mask opening allowing air to escape and lungs deflate.

[0110] Fig. 9B illustrates a variation of a portion of a device 100 showing a mask 14 having a trigger 186 that is coupled to an exhaust port 116. In this variation, the mask 114 also includes one or more pressure release valves 117 that will crack or permit flow beyond an established pressure. Such a fail-safe presents unsafe pressurization of the airway by the device. The pressure release valves 117 can be surrounded by protrusions or features 115 that prevent objects from blocking the valves 117. The device 100 is also shown with an adjustment control 1.83 that permits movement of the mask 114 along the tube 110, FIG. SB also illustrates a tubing 1.85 that couples the trigger 1.86 to the sensor lumen 184. As shown, the sensor lumen 184 can he coupled with a t-fltting or other fluid coupling so that a portion of the lumen is in fluid communication with the trigger 186 as described below.

[0111] FIG. 9C illustrates a partial cross sectional view of the mask X 1.4 and tubing 110. As shown, when the mask is positioned against the respiratory opening of the patient (i.e,, a month or nose), airflow from the expiratory cycle (represented by arrows 109) flow through a portion of the mask 114 and into a chamber 113 that is in fluid communi cation with the exhaust lumens 117. However, in this condition, the trigger 186 is not being PCT/US2015/022079 WO 2015/143452 pressed against the mask 114 such that the exhaust port 116 remains open allowing airflow 109 to exit the mask. Furthermore, the trigger ISO can be positioned in a shaft having a compressible air volume 111 that is in fluid communication with the tubing 185. Accordingly, although the mask 114 is pressed against the patient, the exhaust port 116 permits the system to be open (fluidly open).

[01121 FIG. 9D illustrates a condition where the trigger is pressed or actuated (the trigger can be on a spring return or have elasticity to function as a spring return). Once actuated, the trigger 186 fluidly closes the system by closing the exhaust port 116. The action of the trigger 186 can also be used ini tiate a manual bolus of air through the tubing 110. For example, the trigger 186 can have one or more electrical contacts or switches in region 111 that provides a signal to the control system to deliver a bolus of air. in an additional configuration, actuation of the trigger 186 compresses the volume of air in space 111 causing a pressure increase P2 in tube 185, which is coupled to the sensor lumen 184, this increase in pressure causes the sensor lumen to perform a manual ventilation by delivering a bolus of air through the tubing 110. Likewise, when the trigger 186 is released, the expansion in volume of region 1 1 1 creates a drop in pressure in tubing 185 as well as in the sensor lumen 184, where the drop in pressure is registered by the sensor to stop ventilation.

[0113 j In addition to the sensor 180 and/or sensor lumen 184 the device 100 can include any number of additional lumens to provide information to monitoring equipment. For example, the device can include one or more lumens that are fluidly coupleabie to a capnograph device. Alternatively, or in combination, the sensor lumen 1.84 can also allow fluid coupling to a monitoring device. In such a case, the lumens can be coupled to one or more openings (such as 180) located on the working end of the device.

[01141 FIG. 10A illustrates an example of the working end 102 of the device 100 when inserted into a body passageway of an individual. In this example, the device is inserted into a trachea 18, where the device 100 detects that it is in an airway as described above. However, as shown in FIG, 10B, variations of the device 1.00 can also be positioned in the esophagus 1.6 using the process described above, which temporally seals the esophagus 1.6 to deliver air to the .respiratory passage 18.

[0115] In either case, the device 1.00 is configured to begin assisted ventilation by delivering a bolus of air 40 at a pre-determined rate. The device '1.00 is configured to measure a condition of a thoracic cavity to determine a change in the thoracic cavity, either through pressure within the thoracic cavity as denoted by FT or a force F applied to the PCT/US2015/022079 WO 2015/143452 thoracic cavity via chest compressions. In the latter case, the force F applied to the chest causes movement of tissue (such as the trachea or other tissue) that can be determined by a force detecting component 190 as disc ussed above. The detection of a chance in the thoracic cavity by measuring a fluid characteristic such as a change in pressure FT is typically measured within a body passageway (such as the trachea 18 or esophagus 16). Such measurements can include measuring flow rate of air, volume, pressure, etc.

[0116] In one variation, the initial or predetermine rate comprises 100 ventilations per minute (i.e., a bolus of air is delivered 100 times per minute). However, any rate of delivery is within the scope of this disclosure. Upon detecting a change in die condition of the thoracic cavity', typically due to chest compressions, the device 100 will adjust the timing and/or rate of air delivery to achieve an optimum result. For example, the system can deliver a bolus of air upon detecting the chest compression (either by die force measurement or via the fluid sensor measurement). In such a case, the bolus of air increases pressure in the thoracic cavity to serve as an internal chest compression which compresses the heart and lungs from within causing increased blood flow'.

[0117] In variations of the device, the system monitors for a change in a condition of the thoracic cavity on. a continuous basis, or on a delay. In either case, the system can be configured to not respond to a change in the pressure of the thoracic cavity dri ven by the deli very of the bolus of air. For example, the system can ignore readings during and immediately after the delivery of the bolus of air.

[0118] The process of adjusting the delivery' of a bolus of air (either by timing and/or rate) in response to a particular phase of the chest compression is intended for use during CPR. However, the assisted ventilation can be accomplished whether using a mechanical compression system or a caregiver performing manual chest compressions.

[0119] The alteration of the timing and/or rate is intended to provide a bolus of air with each or a specific number of compression and at a specific phase of the compression of the patient's chest. As noted herein, the ventilations are timed in a way that both increased the efficiency of the chest compression by increasing intrathorasic pressure during the down stroke of the chest compression, which would increase the pressure on the heart thus increasing blood flow. During the up stroke of the compression the a portion of the ventilation could still be given to allow new air enter the alveoli while allowing a portion of the up stroke of die compression to create a negative intrathorasic pressure drawing blood back into the heart and air into the alveoli. This technique also prevents a rescuer from PCT/US2015/022079 WO 2015/143452 having to pause compressions in order gi ve ventilations, which, decreases blood flow and decreases odds o.f patient’s survival.

[0120) When using the devices described herein, regardless of whether the de vice is positioned in the trachea or esophagus, the airway is always opened to the outside environment which greatly reduces, if not eliminates, the chance of barotrauma.

[01211 The data generated by the devices described herein regarding the efficiency of the compression regarding depth, rate, recoil time can be analyzed and presented via feedback to the caregiver in order to maximize die efficiency of the compressions. All of this information and be used to increase the efficiency of the compressions and therefore increase blood flow of the patient and increasing patients chance of survival. If using a mechanical compression system the cycle phase could be directly linked to the device 100. [0122) Furthermore, the system can be configured to return to a predetermine rate of providing the bolus of air, if at any time chest compression stop/pause. In such a case, the system can monitor the amount of time during which a change in the thoracic cavity is not detected. If.no change is detected for a pre-set time, the control unit can reset the rate of assisted ventilation to the initial rate or an alternate rate that is not dependent upon chest compression. In addition, if the patient’s pulse resumes, the system can continue to provide assisted ventilation at a pre-determined rate, volume, etc. Alternatively, the system can enter a manual mode where a caregiver can deliver assisted ventilation upon demand (e.g., using the manual trigger button). Furthermore, the system can be configured to check for a patient’s pulse and use identification of tire pulse to adjust the rate of assisted ventilation or cease assisted ventilation. )0123) The manual trigger allows the caregiver to give a controlled ventilation on demand button may be beneficial once the patient has regained a pulse eliminating the need for external chest compression. As noted above, the device 100 can still continue isolation of the lungs by collapsing the esophagus with suction and/or direct air through the proper lumen into the lungs but. changes the ventilation to an air bolus given on demand given by the caregiver. The manual trigger allows the caregiver to start the flow of air to the lungs. Release of the trigger stops the flow of air to the lungs to allow the patient to exhale, Alternatively, a single actuation of the trigger can give a preset amount of air that ventilates the patient. )0124) The system described herein can also be used with conventional rescue devices. For example, the ventilation system can be configured to work with an active chest compression device so that ventilations and chest compressions are timed to increase 26 PCT/US2015/022079 WO 2015/143452 effectiveness of both the compression and ventilation. The coupling can he mechanical and/or electrical. The ventilation system can. also include carbon dioxide sampling so that carbon dioxide levels are outputted via a signal or gas stream to a monitor or other notification means as described herein, [0125] FIGS. 11A and 11B illustrate a variation of a system for artificially ventilating an individual using a source of oxygen, such as those described herein. In the illustrated example, the device 100 is not shown for purposes of clarity in illustration how the control system 150 can be used as a stand-alone unit having electrical control systems having firmware can be controlled through the system interface 152, or can be integrated or controlled with an external device (e.g,, a cardiac monitor, monitor/defibrillator, or other critical care device). As shown, the control unit 150 can be mounted on the external device 162 and coupled to a source of oxygen 160. As shown in FIG. 1 IB, once coupled to the external device 162, the control unit 150 can be operated using the on-board controls 152 or can be controlled via the external device 162 via a wireless or wired connection. In such a case and as shown in FIG, 11C, one or more of the on-board controls 152 of the control unit 150 can be displayed on the controi/display 164 of the external device 162. The variation shown in FIG. 11C illustrates controls for operating the device 100 in a CPU mode, on-demand mode, or suction mode. However, any number of items can be displayed on the controi/display 164 and/or on the on-board controls 152.

[0126] For example, the device 100 can display information relating to the phase, rate, efficiency, depth, ratios of chest compression during CPR. Additionally, the device can display information for giving an operator real time feed-back on the efficiency of the assisted compressions via audible or visual feedback as well as information on whether to increase or decrease the speed of manual compressions, or whether to resume chest compressions if pulses are lost or the caregiver stops chest compression for too long.

[0127] The device 100 can also be configured with a rechar geable power supply that can be charged when coupled to an external device 162, or where the connection allows for charging the device 100 via a typical AC power source. In most cases, the control unit 150 will carry a power supply capable of powering the device for a sufficient period of operation and a sufficient stand-by period.

[0128] FIG. 12 illustrates an additional improvement to increasing the portability of the control unit 150. in this con figuration, the control unit 150 rel ies upon the source of oxygen 160 to provide ventilation to the individual as well as to produce the vacuum described above. Accordingly, to extend the source of the oxygen, the device can employ one or more 27 PCT/US2015/022079 WO 2015/143452 vacuum valves 200, 202 that produce a vacuum as a result of the pressurized flow of oxygen where one vacuum valve operates at a high flow to generate suction. Once a vacuum is established for a certain period of time, the system can switch to a low flow vacuum valve 202 that generates high vacuum with low flow. Such a configuration extends the life of the oxygen supply.

[01291 1» another variation, the devices described herein can be used to determine ventilation parameters using tubing that accommodates different sizes, For example, having a variety' of working ends of different sizes that were coordinated with a Broslow tape for pediatric applications. This way a caregiver could simple select the size airway the Broslow tape recommended and attach to the ventilator. The caregiver would not have to adjust the ventilation parameters because either the authentication process would signal to the ventilator the approximate size of the patient based on the airway selected. Alternatively, the airway itself would reduce the volume, pressure, suction pressure that the patient recei ved. An example of this method would be a narrowing of the ventilation tubing that restricted flow so the volume ventilated over a peri od of time was less. Another example would be an exhaust valve the dumped excess ventilation volume into the atmosphere, reducing both the volume and pressure for ventilating the patient.

[0130] Method for being able to determine the phase, rate, efficiency, depth, ratios of chest compression during CPR by detecting the bending of a tube placed in the patient's mouth, esophagus via various methods. Including but not limited to, strain gauges on tube, fiber optics, air movement sensors. · A method for timing ventilations at a certain phase of the compression to maximize the efficiency of CPR w hile allowing adequate gas exchange. Using the technology mentioned in the method above attached the ventilator. * A method for continuing ventilations after compressions are stopped or paused. * A method for giving operator real time feed back on the efficiency of rescuers compressions via audible or visual feedback.

[0131] Some of the features of the systems described above include: a method for placing electrodes on the tube and pacing the heart via tube placed in the mouth, esophagus or trachea; a method for defibriHating the heart through electrodes placed on a tube in the mouth, trachea or esophagus of a patient; and a method for determining if the patient has a pulse through a tube in foe patients mouth, trachea or esophagus.

[0132] FIGS. 19-28 illustrate an example of the circuitry for sensing foe phase, rate, depth and effectiveness of a chest compression with a resistor placed on foe tube of an airway placed in the patient’s mouth, trachea or esophagus. The information can be relayed 28 PCT/US2015/022079 WO 2015/143452 to the rescuer of used to-signal a valve to time a ventilation. This is only one example of how to implement the invention described above by no way are we limiting other methods mentioned above.

[0133] The preceding merely illustrates the principles of the invention. It will be appreciated that those skilled in the art will be able to devise various arrangements which., although not explicitly described or shown herein, embody the principles of the invention and are included within its spirit and scope. Furthermore, all. examples and conditional language recited herein are principally intended to aid the reader in understanding the principles of the invention, and the concepts contributed by the inventors to furthering the art, and are to be construed as being without limitation to such specifically recited examples and conditions. Moreover, all statements herein reciting principles, aspects, and embodiments of the invention as well as specific examples thereof are intended to encompass both structural and functional equivalents thereof. Additionally, it is intended that such equivalents include both currently known equivalents and equivalents developed in the future, he., any elements developed that perform the same function, regardless of structure. The scope of the present invention, therefore, is not intended to be limited to the exemplary embodiments shown and described herein. Rather, the scope and spirit of present invention is embodied by the appended claims.

[0134] It must be noted that as used herein and in the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly dictates otherwise, Thus, for example, reference to “a string” may include a plurality of such strings and reference to “the tubular .member” includes reference to one or more tubular members and equivalents thereof known to those skilled in the art, and so forth.

[0135] Where a range of values is provided, it is understood that each intervening value, to the tenth of the unit of the lower limit unless the context dearly dictates otherwise, between the upper and lower limits of that range is also specifically disclosed. Each smaller range between any stated value or intervening value in a stated range and any other stated or intervening value in that stated range is encompassed within the invention. The upper and lower limits of these smaller ranges may independently be included or excluded in the range, and each range where either, neither or both limits are included in the smaller ranges is also encompassed within the invention, subject to any specifically excluded limit in the stated range. W here the stated range includes one or both of the limits, ranges excluding e ither or both of those included limits are also included in foe invention. 29 PCT/US2015/022079 WO 2015/143452 [0136) All publications mentioned herein are incorporated herein by reference to disclose and describe the methods and/or materials in connection with which the publications are cited. The publications discussed herein are provided solely for their disclosure prior to the filing date of the present application. Nothing herein is to be construed as an admission that the present invention is not entitled to antedate such publication by virtue of prior invention. Further, the dates of publication provided may be different from the actual publication dates which may need to be independently confirmed. 30

Claims

We claim;

1. A system artificially ventilating an individual the system comprising': a ventilation device configured for insertion within a respiratory opening of the individual and having a working end for positioning within a body passageway of the individual, the ventilation device having a pressure sensor configured to detect pressure changes within the body passage; the ventilation device having a control system configured to deliver a bolus of air into an airway the individual at a pre-determined rate until detection of the pressure change within the body passageway, whereafter the control system is configured to alter the pre-determined rate hv delaying delivery of the bolus of air until the sensor detects the pressure change in the air within the body passage, where the pressure change within the body passage results from a chest compression.

2. The system of claim 1, where delivering the bolus of air into the airway of the individual occurs after a pre-determined delay.

3. The system of claim 1, where the sensor is configured to intermittently detect pressure changes within the body passageway.

4. The system of claim 1, further comprising, after altering the pre-determined rate, the ventilation device resumes deli vering the bolus of air at the pre-determined rate if the press ure sensor fails to detec t a pressure range withi n a first period of time.

5. The system of claim l, where the ventilation device includes a working end for positioning in the body passageway the individual, where the working end includes a first opening fluidly coupled to a first lumen and a second opening fluidly coupled, to a second lumen, where the second opening is located along the ventilation device proximal to the first opening; and where inserting the ventilation device within the respiratory opening further comprises; drawing suction through the first opening to induce collapse of the body passageway and maintaining the suction for a period of time; monitoring a fluid parameter to determine whether the body passageway collapses; automatically ventilating the individual through the second lumen upon detec ting collapse of the body passageway and maintaining suction to maintain the collapse of the body passageway; and automatically ventilating the individual through die first lumen upon failure to detect collapse of the body passageway; wherein delivery of a bolus of air during automatically ventilating the individual occurs at a first timing; measuring a condition of a thoracic cavity to determine a change in the thoracic cavity; and altering the ti ming of the delivery of the bolus of air during automatically ventilating the individual upon detecting the change in the condition thoracic, cavity.

6. The system of claim 1, where measuring the condition of the thoracic cavity comprises measuring the condition of the thoracic cavity using the ventilation device.

7. The system of claim 1, where measuring the condi tion of the thoracic cavity comprises measuring a change in a compression of a chest of the patient.

8. The system of claim 7, where measuring the change of the compression of the chest of the patient comprises observing a force applied to the ventilation device by the body passageway.

9. The system of claim 6, where measuring the change of the compression of the chest of the patient comprises observing a deflection of the chest of the patient using one or more sensors on the chest.

10. The system of claim 1, where measuring the condition of the thoracic cavity comprises measuring a state of air flow within the thoracic cavity.

11. The system of claim 10, where the ventilation device further comprises a sensor and where measuring the state of air flow within the .thoracic cavity comprises detecting airflow using the sensor.

12. The system of claim 12, where the sensor comprises an air pressure sensor,

13. The system of claim 12, where altering the timing comprises using the sensor to determine when a pressure in the body passageway increases and delivering air for automatically ventilating the individual when the pressure in the body passageway increases, decreases, or reaches a maximum pressure.

14, The system of claim .12, where measuring the state of air flow comprises measuring a direction of air flow.

15. The system of claim 1, further comprising; providing a feedback based on measuring the condition of the thoracic cavity.

16. Tile system of claim 15, where the feedback comprises information regarding die compression, where the information is selected from a phase, rate, efficiency, depth, and timing.

17, The system of claim 15, where providing feedback; based on measuring the condition of the thoracic cavity comprises measuring a quality of the chest compression by determining a change in a volume of air in the thoracic cavity

18 . The system of claim 15, where the feedback comprises information to increase or decrease a. compression applied to a chest of the patient,

19. The system of claim 1, where altering the timing of the ventilation comprises ini tiating automatically ventilating of the individual when a pressure increases in the body passageway.

20. The system of claim 1, where altering the timing of the ventilation comprises initiating automatically ventilating of the individual when a pressure increases in the body passageway.

21. Hie system of claim 20. further comprising continuing measuring the condition of the thoracic cavity to determine the change in the thoracic cavity after altering the timing of automatically ventilating of the individual and reverting to automatically ventilating the individual at the first timing upon failure to detect the change in the thoracic cavity.

22. The system of claim 1, further comprising adjusting the ventilating device to suspend automatically ventilating the individual and manually ventilating the individual while maintaining suction to maintain the vacuum if the vacuum is detected.

23. The system of claim 1, further comprising a mask slidably positioned along the ventilation device.

24. The system of claim 23, further comprising sealing the mask against the individual to isolate the respiratory· opening ofthe individual from an external atmosphere.

:25. The system of claim 1, further comprising electrically stimulating a heart of the individual using the ventilation device.

26. The system of claim 1, further comprising monitoring the individual for a pulse using a portion ofthe ventilation device located in the body kunen.

27. A system for artificial ly venti lating an indi vidual using a source of oxygen, the system comprising: a ventilation device having a pressure sensor configured to detect pressure changes within the body passage, the pressure sensor being positioned on. a portion of the device configured to be inserted into a body passageway ofthe individual; and a controller configured to deliver a bolus of air into an airway the individual at a pre-determined rate, where die controller is configur ed to monitor die pressure sensor and upon detecting a pressure change, the controller alters the pre-determined rate by delaying delivery of the bolus of air.

••28; The system of claim 28. further comprising a manual ventilation trigger, and where the mask forms a sea l on actuation of die manual ventilation trigger.

29. The system of claim 27, where the ventilation device includes a working end for positioning in the body passageway the individual, where the working end includes a first opening fluidly coupled to a first lumen and a second opening fluidly coupled to a second lumen, where the second opening is located along the ventilation device proximal to the first opening; and where inserting the ventilation device within the respiratory opening further comprises; drawing suction through the first opening to induce collapse ofthe body passageway and maintaining the suction for a period of time; monitoring a fluid parameter to determine whether die body passageway collapses; automatically ventilating the individual through the second lumen upon detecting collapse ofthe body passageway and maintaining suction to maintain the collapse of the body passageway; and automatically ventilating the indi vidual through the first lumen upon failure to detect collapse of the body passageway; wherein deli very of a bolus of air during automatically ventilating the individual occurs at a first timing; measuring a condition of a thoracic cavity to determine a change in the thoracic cavity; and altering the timing of the del i very of the bolus of a ir during automatically ventilating the individual upon detecting the change in the condition thoracic cavity.

30, A method for ventilating an individual, the method comprising: inserting a ventilation device into the individual by advancing a working end of the ventilation device within a body passage of the individual» where the working end includes a far opening fluidly coupled to a first lumen and a medial opening fluidly coupled to a second lumen; dra wing suction through the opening and attempting to hold s vacuum through the first lumen and the far opening for a pre-determined period of time; automatically ventilating the individual through the second lumen upon detecting the vacuum during the pre-determined period of time and maintaining suction to maintain the vacuum; and automatically ventilating the individual through the first lumen upon failure to detect the vacuum during the pre-determined period of time; where automatically ventilating the individual occurs at a pre-determined timing; measuring a condition of a thoracic cavity to determine a change in the thoracic cavity; and altering a timing of automatically ventilating of the individual upon detecting the change in the condition of the thoracic cavity,

31. The method of claim 30, where measuring the condition of the thoracic cavity comprises measuring the condition of the thoracic cavity using the venti lation device.

32. The method of claim 30, where measuring the condition of the thoracic cavity comprises measuring a change in a. compression of a chest of the patient.

33. The method of claim 32, where measuring the change of the compression of the chest of the patient comprises observing a force applied to the ventilation device by the body passageway.

34. The method of claim 31, where measuring the change of the compression of the chest of the patient comprises observing a deflection of the chest of the patient using one or more sensors on the chest.

35 . The method of claim 30, where measuring the condition of the thoracic cavity comprises measuring a state of air flow within the thoracic cavity.

36. The .method of claim 35, where the ventilation device further comprises a sensor and where measuring the state of air flow' within the thoracic cavity comprises detecting airflow using the sensor.

37. The method of claim 36, where the sensor comprises an air pressure sensor.

38. The method of claim 36, where altering the timing comprises using the sensor to determine when a pressure in the body passageway increases and delivering air for automatically ventilating the individual when the pressure in the body passageway increases, decreases, or reaches a maximum level.

39. Tire method of claim 36. where measuring the state of air flow comprises measuring a direction of air flow.

40. The method of claim 30, further comprising providing a feedback based on measuring the condition of the thoracic cavity.

41. The method of claim 40, where the feedback comprises information regarding the compression, where the information is selected from a phase, rate, efficiency, depth, and timing.

42. The method of claim 40, where providing feedback based on measuring the condition of the thoracic cavity comprises measuring a quality of the chest compression by determining a change in a volume of air in the thoracic cavity

43. The method of claim 40, where tire feedback comprises information to increase or decrease a compression applied to a chest of the patient.

44. The method of claim 30, where altering the timing of the ventilation comprises initiating automatically'ventilating· of the individual when a pressure increases in the body passageway.

45. Tlie method of claim 30, where altering the timing of the ventilation comprises initiating automatically ventilating of the individual when a pressure increases, decreases, or reaches a maximum level in the body passageway.

46. The method of claim 45, furt her comprising continuing measuring the condition of the thoracic cavity to determine the change in the thoracic cavity after altering the timing of automatically ventilating of the individual and reverting to automatically ventilating the individual at the first timing upon failure to detect the change in the thoracic cavity.

47. The method of claim 30, further comprising adjusting the ventilating device to suspend automatically ventilating the individual and manually ventilating the individual while maintaining suction to maintain the vacuum if the vacuum is detected.

48 . The method of claim 30, further comprising a mask slidably positioned along the ventilation device.

49. The method of claim 48, further comprising sealing the mask against the individual to isolate the respiratory opening of tire individual from an external atmosphere.

50. The method of claim 30, further comprising electrically stimulating a heart, of the individual using the ventilation device,

51. The method of claim 30, further comprising monitoring the individual for a pulse using a portion of the ventilation device located in the body lumen,

52. A method for ventilating an individual, the method comprising: Inserting a ventilation device within a respiratory opening of the individual, and advancing a w orking end of the ventilation devi ce within a body passageway of the individual, where the working end includes a first opening fluidly coupled to a first lumen and a second opening fluidly coupled to a second lumen, where the second opening is located along the ventilation device proximal to the first opening; drawing suction through the first opening to induce collapse of the body passageway and maintaining the suction for a period of time; monitoring a fluid parameter to determine whether the body passageway collapses; automatically ventilating the individual through the second lumen upon detecting collapse of the body passageway and maintaining suction to maintain the collapse of the body passageway; and automatically ventilating the individual through the first lumen upon failure to detect collapse of the body passageway; wherein delivery of a bolus of air during automatically ventilating the individual occurs at a first timing; measuring a condition of a thoracic cavity to determine a change in the thoracic cavity; and altering the timing of the delivery' of the bolus of air during automatically ventilating the individual upon detecting the change in the condition thoracic cavity.

53. A method artificially ventilating an individual, the method comprising: coupling a ventilation, device to a respiratory opening of a respiratory passage of the individual; positioning a pressure sensor in fluid communication with the respiratory passage, the pressure sensor configured to detect pressure changes within the respiratory passage; delivering a bolus of air into the respiratory passage of the individual at a predetermined rate; and altering the pre-determined rate by delaying delivery of the bolus of air until the sensor detects a pressure change in the air within the respiratory passage, where the pressure change within the respiratory passage results from a chest compression,

54. A device for ventilating an individual, the device comprising: a tubular member having at least a first and second lumen, where the first lumen is fluidly coupled to a first opening located distal! y relative to a medial opening, where the medial opening is fluidly coupled to the second lumen, where the first opening and media! opening are each fluidly isolated within the tubular member; the tubular member being configured to measure a condition of a body lumen to determine a change in a thoracic cavity of the individual ; a control system having a suction source and a gas supply lumen, the control system having a valve configured to fluidly couple the gas supply lumen to either the first lumen or to the second lumen; the control system also capable of drawing suc tion from the suction source through the first opening and first lumen, where the control system is configured to monitor the first lumen for a vac uum to indicate collapse of the body passageway and formation of a seal at the first opening; where the control system is further configured to selectively form a ventilation path from the supply lumen to the first lumen or second lumen by selecting the first lumen as the ventilation path if collapse of the body passageway is not detected; and selecting the second lumen as the ventilation path if col lapse of the body passageway is detected; where the control system is configured to automatically ventilate the indi vidual through the ventilation path at a first rate; and where the control system is further configured to alter the first rate upon detecting the condition of the body lumen.

55. The device of claim 54, where the control system is configured to maintain suction while automatically ventilating through the second lumen.

56. The device of claim 54, where the tubular member comprises at least one strain gauge configured to measure the condition of the body lumen to determine the change in a thoracic cavity through deformation of the tubular member,

57. The device of claim 54, further comprising at least one sensor configured to measure the condition of the body lumen to determine the change in a fluid parameter of the thoracic cavity,

58. The device of claim 57, where the sensor is located on or In the tubular member.

59. The device of claim 57, further comprising a sensor lumen extending in or with the tubular member, the measuring lumen in fluid communication with the sensor.

60. The device of claim 57, where the sensor comprises an air pressure sensor configured'.'to detect movement of air within the body lumen, .resulting from 'compression and decompression of a chest of the'patient.

61. The device of claim 54, where the control system is configured to generate a feedback signal based on measuring the condition of the thoracic cavity.

62. Tlie device of claim 61. where the feedback signal comprises information regarding compression of the thoracic cavity selected from group consisting of a phase of compression, a rate of compression, an efficiency of compression, a depth of compression, and a timing of compression,

63. The device of claim 61, where the control system is configured to be coupled to a second medical device.

64. The device of claim 61, where the control system is configured to be coupled to a display device.

65. The device of claim 54, where the control system is configured to continue to monitor the condition of the body lumen cavity to determine the change in the thoracic cavity after altering the first rate and to revert the first rate upon failure to detect the change in the body lumen,

66. The device of claim 54, where the control system comprises a manual mode which is configured to allow a user to manually ventilate the patient through the ventilation path.

67. The device of claim 54, where the control system comprises a manual mode which is configured to allow a user to manually ventilate the patient through the ventilation path.

68. The device of clai m 54, -farther comprising a mask slidably positioned along the tubular member,

69. The device of claim 68, where the mask comprises an edge configured to form a seal against a respiratory open ing of the individual to isolate the respira tory opening from an external atmosphere.

70. The de vice of claim 69, further-comprising a manual ven tila tion trigger, and where the mask forms a seal on actuation of the manual ventilation trigger.

71. The device of claim 54. further comprising at least one electrode located on die tubular member, where the at least one electrode is configured to apply stimulation current to the individual.

72. The device of claim 54, further comprising a pulse monitoring sensor located on the tubular member, the pulse monitoring sensor configured to monitoring a pulse of the individual and transmits a pulse signal to the control system.

73. The device of claim 54, further comprising a capnography lumen extending through the tubular member having a first end terminating at an opening in the tubing and a second end coupleable to a capnograph device.